The predictive value of four scoring systems in liver transplant recipients

Objective To compare 4 general severity classification scoring systems concerning prognosis of outcome in 123 liver transplant recipients. The compared scoring systems were: the mortality prediction model (admission model and 24 h model); the simplified acute physiology score; the acute physiology and chronic health evaluation (Apache II) and the acute organ systems failre score. Design Retrospective, consecutive sample. Setting Adult intensive care unit in a university hospital. Patients 123 adult liver allograft recipients after admission to the intensive care unit. Measurements and main results The scoring systems were calculated as described by the authors to classify the severity of illness after admission of the allograft recipients to the intensive care unit. The mean and median values of survivors and the group of patients, that died during hospital stay were compared. Receiver-operating characteristics were plotted for all scoring systems and the areas under the curves of receiver-operating characteristics were calculated. The predictive value of the 4 scoring systems was tested using a variety of sensitivity analyses. The mortality prediction model (24 h model) was found to have a high significance (p<0.001) in predicting mortality and showed the greatest area under the curve (0.829). Simplified acute physiology score (p<0.001) and acute physiology and chronic health evaluation (Apache II) (p<0.01) had a high significance as well, but did not hit the level of prognosis of mortality prediction model, as shown in the area under the curves. Accordingly, sensitivity was highest in MPM-24 h (83%), followed by SAPS (72%) and Apache II (71%). MPM-24h had a total misclassification rate of 22% (SAPS=32%, Apache II=33%). MPM-admission failed in predicting mortality (sensitivity=52%). Organ systems failure score seemed not to be useful in liver transplant recipients. Conclusion General disease classification systems, such as the mortality prediction model, simplified acute physiology score or acute physiology and chronic health evaluation are good mortality prediction models in patients after liver transplantation. We suggest that there is no need for improvement of a special scoring system.     

复合指数评分系统在慢性阻塞性肺疾病中的应用价值

多参数指数评分系统通过对慢性阻塞性肺疾病(COPD)患者进行多方面评分,可以预测患的一般健康状况、恶化风险以及死亡风险,为临床医师调整治疗方案提供一定的参考价值。目前最常见的多参数评分系统有DOSE指数、BODE指数和ADO指数。DOSE指数包括呼吸困难程度、气流受限程度、目前吸烟状态以及年恶化次数的评分;BODE指数包括体重指数、气流受限程度、呼吸困难程度及6分钟步行试验的评分。ADO指数包括年龄、呼吸困难程度及气流受限程度的评分。本文对上述评分系统的应用情况进行了综述。     

三种检查在膀胱肿瘤诊断和病理分期中的价值分析

目的 探讨超声、CT和膀胱镜检查在膀胱肿瘤诊断和病理分期中的应用价值.方法 采用超声、CT和膀胱镜对手术确诊的80例膀胱肿瘤患者进行检查和分期,比较检查结果和病人的病理情况.结果 超声检查肿瘤检出69例,灵敏度为86.3%,特异度为80.0%;CT检出肿瘤73例,灵敏度为91.3%,特异度为93.3%;膀胱镜检出肿瘤60例,灵敏度为75.0%,特异度为100.0%.结论 80例膀胱肿瘤患者通过不同方法进行临床病理分析,确定了病情和病理分期,为后期治疗奠定了基础.     

内镜黏膜下剥离术治疗胃癌前病变及早期癌的三年疗效评价

目的评价内镜黏膜下剥离术(ESD)治疗胃癌前病变和早期癌的远期疗效。方法对2006年6月至2009年6月在复旦大学附属中山医院内镜中心经ESD治疗的153例早期胃癌和癌前病变患者的临床病理和随访资料进行总结,分析ESD治疗的一次性完整切除率、并发症发生率和远期疗效。结果 153例患者中包括早期胃癌26例(17%),高级别上皮内瘤变67例(43.8%),低级别上皮内瘤变60例(39.2%);ESD一次性整块切除率为98.0%(150/153),一次性完整切除率为94.8%(145/153),组织学完整治愈率为94.8%(145/153)。术中穿孔5例(3.3%),术后迟发性出血9例(5.9%),均予保守治疗治愈;ESD术后3年内病变复发3例,总复发率为2.1%(3/140);140例患者获得随访,随访率为91.5%,随访时间11～54(35.1±22.8)个月;死亡1例,3年生存率为99.3%(152/153)。结论 ESD治疗胃癌前病变和早期癌是一种安全、远期疗效肯定的方法,值得推广。     

两种癫痫发作分类体系临床价值和可信度的比较研究

目的:评估和比较两种癫痫发作分类体系即发作症状学分类法(SSC)和国际癫痫发作分类法(ICES)的临床价值和可信度。方法:2名医生独立地观看106例患者发作的录像资料,采用双盲法对患者的每一次发作录像仔细进行回顾分析并分别使用上述两种分类法进行分类,数据进行百分比计算及Kappa一致性检验。结果:106例患者共计有256次发作,对2名医生诊断的一致性进行比较,结果显示SSC明显高于ICES。SSC体系中一些症状如过度运动发作、自动运动发作、愣神发作等具有更高的一致性。结论:SSC提供了一个比ICES更为容易理解的癫痫发作分类体系,提示SSC是一种非常有用的、可靠的分类方法。     

三维超声断层显像技术对胎儿泌尿系统畸形的诊断价值

目的探讨三维超声断层显像技术对产前胎儿泌尿系统畸形的诊断价值。方法回顾性分析2011~2014年门诊产前检查经三维超声断层显像、二维超声检查拟诊断为泌尿系统畸形的42例胎儿的临床资料,以产后超声、MRI、手术或尸检结果作为金标准,对两种产前检查方法进行诊断学效能评价。结果经产后超声、MRI、手术或尸检结果最终诊断的泌尿系统畸形有41例,二维超声诊断重复肾输尿管末端闭锁或异位、双肾发育不全、一侧肾缺如、多囊肾的结果与最终诊断的符合率均为100%,总体对泌尿系统畸形的诊断符合率达到80.49%;三维超声断层显像诊断一侧肾发育不全或不良、肾积水、重复肾输尿管末端闭锁或异位、一侧肾缺如、单发肾囊肿、多囊肾、马蹄肾的结果与最终诊断结果符合率达到100%,整体诊断符合率达到95.12%。三维超声断层显像技术诊断的符合率显著的高于二维超声(χ2=4.100,P0.05)。二维超声诊断的灵敏度为80.49%,特异度为100%,漏诊率为19.51%,误诊率为0。三维超声断层显像诊断的灵敏度为95.12%,特异度为100%,漏诊率为4.88%,误诊率为0。结论三维超声断层显像技术对产前胎儿泌尿系统畸形具有较高的诊断价值。     

通过不同检测系统评价降钙素原对血流感染的临床诊断价值

目的 通过溯源及检测原理不同的两种仪器评价降钙素原对血流感染的临床诊断价值.方法 选取北京协和医院门诊及住院血培养报警阳性的患者标本91份及体检健康标本100份,分别使用VIDAS 30全自动免疫分析仪(简称VIDAS 30)及iFlash 3000化学发光免疫分析仪(简称iFlash 3000)检测降钙素原,分析其变...     

新鲜血清赋值传递提高不同生化检测系统检验结果的可比性

目的通过新鲜血清赋值传递给日常血清校准品的研究,探讨地区性生化检测的量值溯源性和结果可比性的方法。方法选择本地区6家三级综合性医院,检定生化分析仪后,用配套检测系统的校准品的定值和新鲜血清赋值传递校正后的校正值,分别校准仪器,检测患者新鲜混合血清ALT、TC、Urea、TBil等4个项目并与目标系统进行比对,分析不同系统间溯源校准的效果和结果的可比性。结果虽然本研究所用仪器均处于良好状态和较高精密度,但各被测系统对ALT、TC、Urea、TBil等项目的测试结果与目标系统所获结果的可比性较低,结果之间存在较大差异(P<0.01)。经用新鲜血清进行可溯源的准确度传递后,被测系统与目标系统间的可比性提高,所获结果间的差异减小(P>0.05)。结论用新鲜血清进行可溯源的准确度传递,是解决地区性临床化学检测的溯源性和可比性问题的简便实用的方法。     

Three electives

Electives are an important part of students' education and often provide long-lasting memories and friendships, as well as knowledge. The following three accounts are of students who spent their electives in Sweden, Finland and Romania. They report on their experiences abroad, what they learnt from them and draw comparisons with the healthcare system in the United Kingdom.     

A four year study of the personal and interpersonal value systems of freshman nursing students at Yonsei University]

The purpose of this study was to determine the values of freshman nursing students and to determine changes each year over the four years of the study and to provide base data for curriculum and student guidance. The sample consisted of the freshman students who entered college of nursing from 1988 through 1991. The total sample was 358 students and data were collected during March of each of the four years. The data were analyzed using t-test, ANOVA and Pearson Correlation to examine the relationship between the subcategories of values and Duncan multiple range test to examine the relationship between the scores for each year and the demographic data. The instrument used in this study was the Survey of Personal Values and Interpersonal Values modified by UngYun Hwang and KyungHae Lee in accordance with L.V. Gordon's instrument. This tool provides scores on practical mindedness, achievement, variety, decisiveness, orderliness, goal orientation, support, conformity, recognition, independence, benevolence and leadership. The results of the study were as follows: 1. The nursing freshman students surveyed had the highest score for goal orientation (21.44) and the lowest for variety (17.13) on the SPV (Survey of Personal Values) and the highest score for benevolence (21.19) and lowest for leadership (17.00) on the SIV (Survey of Interpersonal Values). In accordance with the standardized scores for Gordon's SPV for other woman college students, the students in the study were between the 78%ile-97%ile and were in the 72%ile-97%ile for the SIV. 2. When t-test scores were compared, no significant variation was found between the years for each of the values (P less than .05). 3. A significant variation was found on variety, between 1989 and 1991 (P less than .05), and between 1988 and 1991. The highest score was in 1991 in both comparisons. Supporting was also higher for 1991 than for 1988 (P less than .05). 4. Religion and occupation of father did not show any significant differences (P less than .05). There was no significant difference in values according to the student's religion or the occupation of their father. Students born in the metropolitan area had a higher score on variety than those from the rural area and vice versa on regularity (P less than .05). The results of this study show that there is a higher score on values for Y University freshman than shown for freshmen in other universities reported from other research. To keep or promote values, it is very important that there be a systematic strategy of education and special educational programs.